Healing of an Asymptomatic Carotid Plaque Ulceration

Abstract

A 72-year-old man with asymptomatic, bilateral, >80% carotid stenoses diagnosed by duplex ultrasound was scheduled for a left carotid endarterectomy (CEA) and a right CEA 2 months later. He underwent in vivo neck magnetic resonance imaging (MRI) examination 1 week before each scheduled CEA. Carotid plaque specimens were subsequently evaluated with ex vivo MRI and histological analysis.1 Histology sections were coregistered with ex vivo (0.5-mm thick) and in vivo (3-mm thick) MR slices using the carotid bifurcation as a point of reference. All in vivo and ex vivo MRI images were measured in millimeters from the bifurcation. The entire CEA sample (10-mm thick) was sectioned every 0.25 mm. Measurements in all modalities were referenced to the superior edge of the bifurcation. The gross morphology and calcified regions of each MR image were used to confirm registration with histology sections.1 The initial neck MRI performed before the left CEA revealed a small dark region protruding into the plaque from the lumen, a characteristic of plaque ulceration (Figure 1A). An ulcer was visualized at the same location in the ex vivo specimen (Figure 1B). Matched ex vivo …